A Quantum Leap In Bone Marrow Aspiration
December 30, 2014
In a nutshell the Jamshidi needle has a hollow center and the fluid is withdrawn from the bottom and side holes (the bottom hole is much larger the the side holes). One important fact to keep in mind when performing a bone marrow aspirate is after you aspirate a few CCs of marrow fluid you are no longer getting marrow aspirate but whole blood. The whole blood fills the marrow cavity in the area where the surgeon is aspirating. The number of stem cells goes down dramatically when you are aspirating from that portion of the marrow cavity that has now filled mainly with whole blood. This has always been the Achilles heel in performing bone marrow aspirations. Bone marrow aspiration technique is very important and can make a significant difference in the overall results obtained. One way to compensate for this is to constantly change the position of the needle. This can make a significant difference but still is probably not be a game changer. A technique which may be a significant improvement is to perform multiple punctures into the bone marrow. The results will be better but the trade off is that we need to make several different punctures into the bone of the pelvis. Most patients have little problems with one marrow puncture but I am not sure how they would tolerate multiple bone marrow puncture sites. Furthermore, being an orthopedic surgeon I am well aware of that multiple puncture sites can lead to stress risers which can lead to bone fractures. Although multiple puncture sites have some pluses the minuses seem to make us want to abandon this approach.
Some time ago I was introduced to a new design in a bone marrow aspiration needle by parties I have worked with for a few years. What this needle does is two fold. First is the fact that the bottom of the needle is closed. This eliminates a problem arising from one of the principles of physics. This principle is that fluids will follow the path of least resistance. Thus with the older types of needle most of the marrow aspirate would be sucked thru the large bottom opening with very little aspirate coming thru the side holes. Remember after a few CCs we are aspirating whole blood not bone marrow aspirate. This is contrary to what we want. The more aspirate coming thru the side holes the higher the cell counts and the lower the amount of whole blood aspirated. The reason for this is we are taking sampling from different areas. However, if we leave the needle is the same position we would still be aspirating large amounts of whole blood. The second intriguing aspect of this new needle is the fact the needle has the ability to be advanced one centimeter at a time. This is done by a clicking mechanism. This is significant in that we can now sample different areas without making different punctures. Normally, we would take about 60 CCs of bone marrow. From this 60CCs we would obtain after processing about 10CCs of finished product. With this new technique we would possibly need only 8-10 CCs of marrow aspirate. Also very significant is the fact that we would probably NOT NEED TO CENTRIFUGE THE ASPIRATE that we obtain with the new needle. This is potentially a giant step in bone marrow processing. I am always suspicious that when we centrifuge bone marrow aspirate we might be throwing away significant aspects of the “bone marrow soup”. Some of these entities might be certain types of exosomes (remember exosomes are the body’s delivery system for growth factors sort of like the body’s Fed Ex system). Another potential “throw away” are Very Small Embryonic Like Stem cells. These are one of the most potent stem cells in the body. They represent the body’s emergency stem cell supplies. There are probably a host of other things we are not even aware of that we eliminate with centrifugation. With these new needles I see only positives and no negatives. This needle will usher in a new age in bone marrow aspirations. There is no stopping the advance of technology. I am certain there will be more to come. We look forward to using these needles after the first of the year.
Thanks Dr. P
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